Jeffrey Eugene Wallace, LICSW, MSW, CDP, MHP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

SC60493319 Issued in WA

Practice address

400 S Jefferson St Ste 200
Spokane, WA 99204-3143

Phone

(509) 822-8662

NPI assigned

Jan 6, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Jeff Wallace Other name

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Resolution Counseling Spokane PLLC

  • Mental Health Counselor
  • Spokane, WA
  • NPI 1083509277
  NPD Authorized official
• Yfa Connections

  • Community/Behavioral Health Agency
  • Spokane, WA
  • NPI 1619058997

  Addiction (Substance Use Disorder)

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1420502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548633600000",
    "number": "1538557012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S JEFFERSON ST STE 200",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992043143",
            "telephone_number": "509-822-8662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S JEFFERSON ST STE 200",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992043143",
            "telephone_number": "509-822-8662"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22 S. Thor St.",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "99202",
            "country_code": "US",
            "telephone_number": "509-532-2000 x32",
            "fax_number": "509-532-2005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JEFFREY",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "credential": "LICSW, MSW, CDP, MHP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-06",
        "last_updated": "2019-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SC60493319",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "SC60493319",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO60490069",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEFF",
            "last_name": "WALLACE",
            "credential": "REV., M.DIV.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Travis Wall
• Rea D Wallace-Vinall, LSWAIC
• Aimee Jennifer Wallace, MSPT
• Andrew Wallace
• Esther Wallace
• Karlen Marie Wallace, PT, DPT
• Mackinze C Wallace, CBT
• Matthew K Wallace, M.D.
• Meghan Koren Wallblom, MA, CCC-SLP
• Patricia Wallender

• Mental Health Counselor in Spokane, WA
• Providers in Spokane, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.